Organization Active NPI

Lo Medical Clinic

  • Primary Care Clinic/Center
  • Roseville, MN
National Provider Identifier
1194877399
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
LO MEDICAL CLINIC
Practice address
2353 Rice St Ste 210
Roseville, MN 55113-3721
Phone
(651) 203-0040
Fax
(651) 486-7594
NPI assigned
Jan 17, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mayka Ly
Title
Administrator
Phone
(651) 203-0040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

2353 Rice St Ste 210
Roseville, MN 55113-3721

Mailing address

2353 Rice St Ste 210
Roseville, MN 55113-3721
Phone (651) 203-0040

National Provider Directory

National Provider Directory

Locations

2353 Rice St
Ste 116
Roseville, MN 55113
Phone (651) 203-0040

2353 Rice St
Ste 210
Roseville, MN 55113
Phone (651) 203-0040

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194877399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2353 RICE ST STE 210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133721",
            "telephone_number": "651-203-0040",
            "fax_number": "651-486-7594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2353 RICE ST STE 210",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551133721",
            "telephone_number": "651-203-0040",
            "fax_number": "651-486-7594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LO MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LY",
        "authorized_official_first_name": "MAYKA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "651-203-0040"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.